Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 2007-00636 | NC |
N | 207V00000X | Obstetrician & Gynecologist | 22400 | SC |
NPI | 1003866427 |
---|---|
Provider Name | Lynn Boardman |
First Address | Charlotte, NC 28219-9305 |
Second Address | Charlotte, NC 28207-2134 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2006 |
Last Update Date | 20/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G04029 | (02) | SC |